title: Health-related quality of life in veterans with prevalent total knee arthroplasty and total hip arthroplasty.
abstract: OBJECTIVE
  To study the HRQOL in veterans with prevalent total knee arthroplasty (TKA) or total hip arthroplasty (THA) and compare them with age- and gender-matched US population and control veteran population without these procedures.
  
  
  METHODS
  A cohort study and cross-sectional survey on veterans obtained demographics and HRQOL with Short-Form 36 for veterans (SF-36V). Veterans were categorized into: primary TKA; primary THA; combination group (>/=1 primary and/or any revision TKA/THA); and control population (no THA/TKA). Multivariable regression compared the physical and mental component summary scores (PCS and MCS scores, respectively) in each group.
  
  
  RESULTS
  Response rate was 58% (40 508/70 334): 531 with TKA, 254 with THA, 461 constituted the combination and 39 262, the control group. Mean PCS scores in veterans with THA, TKA, and combination group were 2 s.d. lower than the US mean (29.5 +/- 0.8; 30.1 +/- 1.1 and 27.1 +/- 0.8). MCS scores were similar to the US mean (47.3 +/- 0.9; 49.1 +/- 1.2 and 45.6 +/- 0.9). Compared with controls, significantly more veterans in TKA, THA or combination groups had multivariable-adjusted PCS </= 30 (55, 64, 71 and 76%; P < 0.0001); similar proportion had MCS </= 30 (15, 12, 8 and 16%; P = 0.29); and mean scores on SF-36 physical domains (P </= 0.0011), but not mental/emotional domains (P >/= 0.01) were statistically and clinically lower.
  
  
  CONCLUSIONS
  Profound physical HRQOL deficits exist in veterans with TKA/THA and in combination group compared with age- and gender-matched general US population and with veteran controls. In these groups, these deficits are not attributable to differences in sociodemographics, comorbidity and healthcare access/utilization. Arthroplasty status may be a surrogate for poorer HRQOL and worse outcomes. Future studies are indicated to determine HRQOL deficit causes and interventions to improve HRQOL in patients with arthroplasty.
authors.affiliation: Minneapolis VA Medical Center, Rheumatology (111R), One Veteran's Drive, Minneapolis, MN 55417, USA. Jasvinder.md@gmail.com
authors.forename: J A
authors.initials: JA
authors.lastname: Singh
authors.forename: J A
authors.initials: JA
authors.lastname: Sloan
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology / Q000534:rehabilitation*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D011788:Quality of Life; D012959:Socioeconomic Factors; D014728:Veterans / Q000523:psychology